Severe bleeding

High urgency
-Very severe

It refers to the outflow or loss of blood from inside the blood vessels between 1500-2000 cc. Bleeding can be arterial, venous or capillary and of internal (inside the body) or external (outside the body) origin.

It can be caused by accidents, lesions, ulcers, varicose veins and other types of diseases.

The clinical symptoms are pallor, cold sweating, tachycardia (rapid heartbeat), tachypnea (rapid breathing), weakness, drop in body temperature, hypotension (drop in blood pressure) and confusion and/or lethargy.

Diagnosis is made by clinical history and physical examination. The complementary explorations to be performed will be complete blood analysis and imaging tests depending on the origin of the bleeding.

Treatment should be carried out at hospital level. It is based on the maintenance of vital signs, the replacement of lost volume and stopping the focus of bleeding through bandages, sutures and/or surgical treatment.

Bibliographic references
  1. American Red Cross. Traumatic injuries. In: American Red Cross First Aid/CPR/AED Participant's Manual. Yardley, PA: StayWell; 2016:chap 6.
  2. Bulger EM, Snyder D, Schoelles K, et al. An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2014;18(2):163-173. PMID: 24641269 www.ncbi.nlm.nih.gov/pubmed/24641269.
  3. Simon BC, Hern HG. Wound management principles. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 52.
  4. G.H. Guyatt,A.D. Oxman,R. Kunz,G.E. Vist,Y. Falck-Ytter,H.J. Schunemann. What is quality of evidence and why is it important to clinicians?. BMJ, 336 (2008), pp. 995-998 http://dx.doi.org/10.1136/bmj.39490.551019.BE. Medline.
  5. G.H. Guyatt,A.D. Oxman,R. Kunz,Y. Falck-Ytter,G.E. Vist,A. Liberati. Going from evidence to recommendations. BMJ., 336 (2008), pp. 1049-1051 http://dx.doi.org/10.1136/bmj.39493.646875.AE. Medline.
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Symptoms

    Severe bleeding > 1500 ml


    Diminished state of consciousness


    Low blood pressure


    Passing little urine


    Cut or wound

Pre-hospital care recommendations

Apply pressure to stop bleeding.
In the event that the blood leaks through the applied bandage, place a new bandage on top of the previous one.
Apply a clean bandage that does not stick to the wound.
If it is not possible to stop the bleeding with compressive bandages, a tourniquet should be applied.